Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial
BackgroundSedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free da...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.1013430/full |
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| author | Eduardo Tobar José I. Farías Verónica Rojas Verónica Rojas Antonello Penna Antonello Penna José I. Egaña José I. Egaña Daniela Ponce Daniela Bravo Felipe Maldonado Abraham Gajardo Rodrigo Gutiérrez Rodrigo Gutiérrez |
| author_facet | Eduardo Tobar José I. Farías Verónica Rojas Verónica Rojas Antonello Penna Antonello Penna José I. Egaña José I. Egaña Daniela Ponce Daniela Bravo Felipe Maldonado Abraham Gajardo Rodrigo Gutiérrez Rodrigo Gutiérrez |
| author_sort | Eduardo Tobar |
| collection | DOAJ |
| description | BackgroundSedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD).MethodsWe conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control (n = 25) or multiparameter group (n = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD).ResultsThere was no difference in VFD at day 30 (median: 11 [IQR 0–20] days in the control group vs. 0 [IQR 0–21] days in the BIS multiparameter group, p = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9–2.8) mg/k/h in the control group vs. 1.9(IQR 1.5–2.2) mg/k/h in the MP group, p = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period.ConclusionA sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration. |
| first_indexed | 2024-04-13T17:08:16Z |
| format | Article |
| id | doaj.art-aea6cf8d0e9241f6896d0471efc7d91c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-13T17:08:16Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-aea6cf8d0e9241f6896d0471efc7d91c2022-12-22T02:38:23ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-11-01910.3389/fmed.2022.10134301013430Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trialEduardo Tobar0José I. Farías1Verónica Rojas2Verónica Rojas3Antonello Penna4Antonello Penna5José I. Egaña6José I. Egaña7Daniela Ponce8Daniela Bravo9Felipe Maldonado10Abraham Gajardo11Rodrigo Gutiérrez12Rodrigo Gutiérrez13Critical Care Unit, Department of Medicine, Hospital Clínico de la Universidad de Chile, Santiago, ChileCritical Care Unit, Department of Medicine, Hospital Clínico de la Universidad de Chile, Santiago, ChileCritical Care Unit, Department of Medicine, Hospital Clínico de la Universidad de Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileDepartment of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileDepartment of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileDepartment of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, ChileDepartment of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileCentro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, ChileDepartment of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, ChileBackgroundSedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD).MethodsWe conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control (n = 25) or multiparameter group (n = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD).ResultsThere was no difference in VFD at day 30 (median: 11 [IQR 0–20] days in the control group vs. 0 [IQR 0–21] days in the BIS multiparameter group, p = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9–2.8) mg/k/h in the control group vs. 1.9(IQR 1.5–2.2) mg/k/h in the MP group, p = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period.ConclusionA sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration.https://www.frontiersin.org/articles/10.3389/fmed.2022.1013430/fullsedationCOVID-19electroencephalogrambispectral indexsuppression ratespectral edge frequency |
| spellingShingle | Eduardo Tobar José I. Farías Verónica Rojas Verónica Rojas Antonello Penna Antonello Penna José I. Egaña José I. Egaña Daniela Ponce Daniela Bravo Felipe Maldonado Abraham Gajardo Rodrigo Gutiérrez Rodrigo Gutiérrez Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial Frontiers in Medicine sedation COVID-19 electroencephalogram bispectral index suppression rate spectral edge frequency |
| title | Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial |
| title_full | Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial |
| title_fullStr | Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial |
| title_full_unstemmed | Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial |
| title_short | Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial |
| title_sort | electroencephalography spectral edge frequency and suppression rate guided sedation in patients with covid 19 a randomized controlled trial |
| topic | sedation COVID-19 electroencephalogram bispectral index suppression rate spectral edge frequency |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.1013430/full |
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